A Mother’s Choice

Women across Kentucky fight for the legal rights of midwives

Chapter 1: No Family Left Behind

Mary Duke waits in a line of people that fill the hallways inside the State Capitol building in Frankfort, Kentucky. She sits down her belongings while her son, Wiley, remains strapped to her chest. She grabs her phone and begins live streaming to the Kentucky Home Birth Coalition’s Facebook page, instantly updating almost 800 people on the schedule for the day. At this point, Mary Duke has become accustomed to waiting. This is her seventh year attending the house and senate sessions.

Six years of being told “no” has not phased the women involved. To them, it is what needs to be done for women, mothers and families.

19 of the 50 states still have legal restrictions on Certified Professional Midwives (CPM) as of 2019. According to The Big Push for Midwives, 35 states have regulated or legalized midwifery since 1976. The most recent legislation passed was in Kentucky and Hawaii in 2019.

In the state of Kentucky, midwives are not legally allowed to attend a home birth due to laws that have not been updated since 1975. Practicing midwives are put into a system that does not recognize the work that they are doing, trained to be doing and have been doing for years.

The Kentucky Home Birth Coalition (KHBC) is a consumer led grassroots organization that seeks licensure for Certified Professional Midwives (CPM). According to KHBC, the coalition was formed so that families in Kentucky have the option to choose hospital alternative birth plans, use evidence-based practices to provide quality care, and protect the rights of families in Kentucky to choose the way that they want in order to bring life into the world, supporting healthy family systems surrounding birth.

According to KHBC, the only law governing direct-entry midwives states that they must obtain a “permit” from the state in order to legally practice. However, the Kentucky Cabinet for Health and Family Services has not issued any new permits since 1975. This ultimately leaves the midwives vulnerable to operating under an illegal status.

Many midwives do not market their businesses online or describe in detail the services that are offered due to the fear of it not being in accordance with the law. For seven years, KHBC (Kentucky Home Birth Coalition) has been fighting for the representation of these women.

Historically, midwives have been in the homes of many women and families over the decades. The relationships formed become more than client-patient relationships. They develop into a trust between mother and midwife that is often absent in patient-hospital relationships.

Home birth provides women with an alternative to traditional medicine and birthing options. According to Mary Duke, there are three main reasons why women may choose home birth, “for some women it is the only option because they don’t have access to hospitals, some women may have had a traumatic experience at a hospital and lastly home is where they are the most comfortable.”

Every family begins with people you trust. In moments where you are bringing new life into the world, you want to trust every person in the room. Wantina Brooks-Roach has been chosen to be that trusted person for more than 1,000 families.

Everyday Wantina Brooks-Roach, a Certified Professional Midwife, wakes up and visits with families all over the Tristate area. Brooks-Roach is a midwife for Ohio, Indiana and Kentucky. All three states have laws restricting Certified Professional Midwives. Clients in Indiana, including the Amish community, travel to her for prenatal, birth and postnatal care.

Wantina has given birth five times. Three of the five times were home births and all five times a Certified Professional Midwife was present. According to Brooks-Roach her goal is to make every family feels comfortable and safe.

“I truly believe that properly supporting and informing a family changes how they respond to the world. I hope the generation of babies that I have had the privilege to assist in welcoming to this earth will bring so much peace and acceptance to world as a result of their families birth choices,” Brooks-Roach said.

Wantina began her training in Indiana with three Certified Professional Midwives. Since moving to Kentucky, four years ago, Wantina has been involved in the Kentucky Home Birth Association and has been an active member in the legislative process.

Most of her clients live in rural areas throughout Kentucky, Ohio and Indiana. In those areas, Brooks-Roach can be a family’s only option. According to theKentucky Census, the population per square mile in Kentucky is 109.9 compared to California at 8,092.3.

Brooks-Roach has a strict schedule. According to her, Mondays are reserved for her Amish clients. “They don’t have phones, so communication can be hard. I know they will be home on Mondays, so I go visit them then,” Brooks-Roach said.

Tuesday is paperwork day for Brook-Roach “it’s an all day thing at the desk,” Brooks-Roach said. Wednesday and Thursday are office days, 8am-8pm. On Fridays, she does home visits. Monday through Friday I start my day at 5am and it’s a full day from there. On Saturday, “I breathe”, Brooks-Roach said.

According to Brooks-Roach home birth is a valid choice for low-risk moms, the key is that there is a choice involved. Midwives ensure privacy and respect to all families Brooks-Roach said.

Chapter 3: The Seven Year Battle

Frankfort Pushes Back

SB84 passed in the House and the Senate on Wednesday March 13th.The Kentucky midwife coalition has advocated for legislation like SB84 since 2012. The passing of this bill is monumental in the fight for licensure, the right to choose home-birth, and the ability to work peacefully and collaboratively with the health care system to provide the best experience for mothers.

The coalition has followed bill SB84 which outlines that midwives who have been nationally accredited using educational requirements under MERA (Midwife Education Standards) as CPM’s would be formally licensed.

This bill would ensure that there is a system of checks and balances for midwives in the form of an advisory panel who would be tasked with recommending regulations and handling disciplinary action and more. The bill also outlines the importance of CPM’s and the hospital system working together for the best interest of the expecting mothers.

The coalition was formed so that families in Kentucky have the option to choose hospital alternative birth plans, use evidence-based practices to provide quality care and protect the rights of families in Kentucky to choose the way that they want to birth, promoting healthy family systems and collaborative support surrounding birth.

While there has been a majority of support coming from both the House and the Senate, as well as the community, there has also been opposition. Some of the opposing viewpoints came from Senator Ralph Alvarado, House Representative Chad McCoy and some national organizations such as ACOG (The American College of Obstetricians and Gynecologists) and Kentucky Coalition of Nurse Practitioners and Nurse Midwives.

House Representative, Chad McCoy, voiced his hesitation during the Licensing and Occupations Committee hearing on March 6, 2019. Oppositions included the idea that SB84 unintentionally created an unconstitutional framework.

McCoy has not been the only group or individual to voice their opinion on the matter. Health organizations such as ACOG (The American College of Obstetricians and Gynecologists) voiced their concerns about access and regulations for the certification of CPMs. The Kentucky Home Birth Coalition (KHBC) worked with the organizations and members of the legislature to ensure a positive outcome.

The Final Vote

March 13, 2019 will be a day for the women of Kentucky to remember for a long time. The “yes” vote on Senate Bill 84 affirmed that Kentucky women have the right to choose their own birthing options. According to Mary Duke the passing of this bill mended a “human rights issue.”

Senator, John Schikle, spoke in response to the vote on March 14, 2019, during the concurrence vote. “This is a historic day for midwives for health care and for the children of Kentucky,” Schikle said.

Senator Ralph Alvarado came forward after long opposing the bill and KHBC’s multiple attempts to get their legislation passed. This was the first time that Alvarado has spoken publicly in favor of the Kentucky Home Birth Coalitions efforts and bill.

“Many of you have heard my opposition and my concerns in the past I want to commend a lot of the midwives and the national organizations that got involved in this. Many of the concerns and issues that I had, I feel have been addressed and I feel very proud to now support this bill”. Alvarado said.

KHBC worked with other organization such as ACOG, Kentucky Hospital Association, Kentucky Medical Association and Dr. Goldberg, an Obstetrician. Throughout the seven-year process, KHBC worked alongside many of the national and state organizations to make sure everything that was being communicated in SB84 was something that fell in line with all organizations.

What will change?

Many women in Kentucky have wanted to have home births but have not wanted to risk the legal allegations and social stigmas that can sometimes follow.

The new law will take effect on June 27, of 2019. Before the law takes effect there will be nominations for the CPM Advisory Council. The council will be comprised of the following: 3CPMs (certified professional midwives), 2 CNM (certified nurse midwives), 2 obstetricians, 1 neonatal provider, 1 member of the general public.

Wantina Brook-Roach believes that with the new laws and regulations there will be an easier transition for women consulting with midwives and transfers to hospitals along with representation at a state level and more.

“I’m hoping it will make insurance billing faster and easier, that’s my biggest hope. I’m also hoping it will make it easier for people to find me and I’m hoping it will level the playing field so we don’t have doctors and nurse midwives telling our clients that they can’t legally have a home birth, because you can,” Wantina said.

According to a CDC report issued in 2013 the percentage of home births in Kentucky grew from “0.69% in 2004 to 1.0% in 2011.”

This is above the national average of 0.79%. Kentucky families choose home birth for many diverse religious, cultural and ideological reasons. The effects of this bill will enable the families and women who make up the one percent to choose the way they want to bring a child into this world without fear of the legal system.